Hernias in trocar ports following abdominal laparoscopy. A review

With increasing numbers of laparoscopies in gynecologic surgery as well as the use of larger trocars more post-operative hernias can be expected. Most hernias occur as Richter's hernias without peritoneal lining and contain small or large intestines or omentum. The incidence is around 1%, but rising with increasing size of trocars. About one fourth of hernias are umbilical, the rest located extraumbilical.

The diagnosis is typically based on the presence of vomiting or nausea with an extended and painful abdomen within two weeks of surgery and can be established by a small bowel series. However, the course can be prolonged and ileus can occur up to one year following laparoscopy. In the majority of cases the hernial content was small intestines or omentum.

In order to reduce the frequency of trocar hernias it is recommended to apply small trocars. Fascial closure must be done when trocars of 10 mm or larger have been employed and the surgeon must ensure that peritoneal tissue is not drawn into the trocar canals when removing the probes. Also, umbilical hernias must be ruled out and, if found, closure must include the complete fascial defect. There are several techniques available for fascial closure. It is concluded that all precautions including fascial suturing must be taken to reduce the 1% incidence of post-laparoscopy hernias.